Author: Rachel Sanborn, M.D., Providence Cancer Institute
“I know two women who have lung cancer, and neither of them has ever smoked. How could this happen to them? I thought lung cancer was caused by smoking.”
I hear this type of question often. I wish I could say that if you never smoked, you'd never get lung cancer. It's true that if we eliminated tobacco, we could prevent about 90 percent of future lung cancers in the United States. However, it wouldn't prevent all of them. There are many other risk factors which can cause lung cancer. About 10 percent of men and 20 percent of women who develop lung cancer in the United States have never smoked.
Major risk factors, other than smoking
In the United States, the second leading cause – and the most common cause in nonsmokers – is radon. This naturally occurring radioactive gas seeps into homes from the ground and can build up to levels that are high enough to cause lung cancer. The U.S. Environmental Protection Agency estimates that this very common, colorless, odorless gas is responsible for as many as 21,000 lung cancer deaths in our country each year.
Secondhand smoke plays a role as well. Nonsmokers who are exposed to secondhand smoke increase their risk of developing lung cancer by 20 to 30 percent. People who grew up in smoking households are at particularly high risk. They were exposed to cancer-causing agents on a regular basis while their lungs were still developing. When we see lung cancer in nonsmokers in their 30s and 40s, the most likely causes are early exposure to household cigarette smoke or radon.
A third, and increasing, contributor is environmental pollution. The World Health Organization cites air pollution as the world's worst environmental carcinogen. While this is a bigger problem in industrialized regions with fewer pollution controls, such as China and East Asia, air pollution still plays a problematic role in the U.S. as well.
What makes lung cancer so devastating is that it strikes in a place you can't see and causes changes that you can't feel. In nonsmokers, it is so unexpected that it's not usually discovered until symptoms do arise, and by then, it may be very advanced.
Lung cancer is the No. 1 cause of cancer deaths worldwide, but it's in our power to change that. We can reduce the number of deaths from this disease, both in smokers and in nonsmokers, by talking about it, being aware of it and working together to take action.
Six ways your patients can protect themselves
1. Test homes for radon. The EPA estimates that 1 out of every 15 homes in the U.S. has unsafe radon levels. According to the Oregon Health Authority, some areas in Oregon, particularly in the Portland metropolitan area, are at high risk of elevated radon levels. In Multnomah County, it's closer to 1 out of 3. In Clackamas County 28 percent of homes have elevated radon levels, and in Washington County, it’s 11 percent. (Check your county's statistics here.) Conducting radon tests is easy, and the best time to do it is during winter months. Inexpensive test kits are available at most home improvement stores. If your radon test result is high, work with a certified radon mitigation professional to improve your home. And spread the word among your friends and family members.
2. Avoid smoking and secondhand smoke. The biggest impact we can make on reducing lung cancer is to eliminate tobacco use and tobacco exposure. Take advantage of every resource to help a smoker quit for good.
3. Educate kids about the harm of tobacco use. Nearly everyone addicted to tobacco today started the habit as a teenager. If young people can resist smoking and vaping through their teen years, there is a strong likelihood they will remain smoke-free for life. Read this important article on how to keep kids from using tobacco.
4. Work to reduce pollution. We know that exposure to diesel exhaust and other pollutants increases the risk of lung cancer. Any action you can take to support clean air and water is hugely important to the community’s health.
5. Eat for better health. Shift eating habits toward a Mediterranean-style diet, which focuses on vegetables, fruits and whole grains. This has been shown to reduce cancer risks, as well as risks for heart disease, diabetes and obesity. Follow our nutrition blog for healthy eating tips and resources.
6. If your patients currently smoke or have smoked, they should talk with their doctor about lung cancer screening. The U.S. Preventive Services Task Force recommends yearly, low-dose computed tomography (LDCT) screening for people between the ages of 50 and 80 who've smoked the equivalent of a pack a day for 20 years or longer, even if they've quit in the last 15 years.
Evidence shows that annual screening can reduce deaths from lung cancer by up to 20 percent, and screening patients at a younger age with lighter pack years of smoking shows a moderate clinical benefit in lung cancer screening.
It takes time for all health insurers and self-insured employers to adopt cancer screening recommendations. Patients should contact their health insurance provider to learn about their insurance coverage for lung cancer screening.
Learn more about Providence Cancer Institute’s Lung Cancer Screening Program.
Innovative treatments for lung cancer
It’s important for your patients to know that not everyone who gets lung cancer dies from it. Treatment does help, some cancers can be cured, and we are learning more all the time. The researchers at Providence Cancer Institute are pioneering new ways to help the body's immune system fight cancer. Multiple clinical trials of new, targeted therapies for lung cancer are also happening at the institute.
It's a very exciting time to be in this field, particularly with recent breakthroughs we have seen in immunotherapy. There is a lot more promise now than we've seen before, and that's very encouraging.
Rachel Sanborn, M.D., is a medical oncologist and medical director of the Providence Thoracic Oncology Program at Providence Cancer Institute, and medical director of the Phase I Clinical Trials Program at the Earle A. Chiles Research Institute, a division of Providence Cancer Institute.
To learn more
- Visit the Providence Thoracic Oncology Program webpage: https://www.providence.org/lungcancer
- Watch an interview with Dr. Sanborn on KATU Afternoon Live: https://youtu.be/n_QrI-znz-w
- View a presentation by Dr. Sanborn at Providence Grand Rounds on “Perspectives in Precision Medicine – Targeting KRAS in Non-Small Cell Lung Cancer”: https://caregiverheadlines.org/genomics-research-kras-g12c-mutations-in-cancer/
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